Provider Demographics
NPI:1306834890
Name:FERAYORNI, JULIAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:JOHN
Last Name:FERAYORNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E COMMERCIAL BLVD
Mailing Address - Street 2:#202
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3760
Mailing Address - Country:US
Mailing Address - Phone:954-772-2767
Mailing Address - Fax:954-772-0619
Practice Address - Street 1:1815 E COMMERCIAL BLVD
Practice Address - Street 2:#202
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3760
Practice Address - Country:US
Practice Address - Phone:954-772-2767
Practice Address - Fax:954-772-0619
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054327600Medicaid
FL93124Medicare ID - Type Unspecified
FL054327600Medicaid